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Dashboard > Reducing Length of Stay


 

Bed day saving % 14.19
Opportunity £232,317,317
Volume Opportunity 1,197M
Rank 1

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Treatment Function Bed day saving % Financial Opportunity Volume Opportunity Rank
General Medicine 14.24 £67,730,500 363,549 1
Geriatric Medicine 16.40 £22,497,887 127,442 1
Trauma & Orthopaedics 11.83 £19,911,936 100,214 1
General Surgery 11.75 £14,535,765 72,999 1
Cardiology 15.02 £9,834,292 51,213 1
Paediatrics 15.07 £9,567,601 34,827 1
Neonatology 17.91 £8,759,250 32,120 1
Respiratory Medicine (Thoracic Medicine) 14.74 £8,088,101 45,140 1
Gastroenterology 14.83 £7,771,131 42,070 1
Accident & Emergency (A&E) 13.95 £6,024,593 30,501 1
Rehabilitation 19.79 £3,921,781 25,446 1
Urology 11.58 £3,907,736 20,065 1
Stroke Medicine 18.12 £3,434,688 19,120 1
Clinical Haematology 15.02 £3,335,153 15,988 1
Neurosurgery 14.51 £3,303,481 16,821 1
Nephrology 15.98 £3,137,192 16,525 1
Vascular Surgery 13.36 £3,133,828 15,456 1
Neurology 18.65 £2,427,466 13,872 1
Gynaecology 11.50 £2,263,085 9,627 1
Colorectal Surgery 10.53 £1,993,788 9,960 1
Ear, Nose & Throat (ENT) 12.05 £1,803,489 8,514 1
Critical Care Medicine 16.14 £1,707,404 9,576 1
Endocrinology 16.37 £1,439,704 7,914 1
Cardiac Surgery 10.37 £1,432,726 7,474 1
Diabetic Medicine 15.41 £1,416,311 8,264 1
Clinical Oncology (previously Radiotherapy) 13.04 £1,411,072 7,059 1
Medical Oncology 12.78 £1,339,114 6,677 1
Plastic Surgery 13.36 £1,039,563 5,234 1
Paediatric Surgery 14.44 £995,731 3,988 1
Upper Gastrointestinal Surgery 11.69 £919,350 4,512 1
Hepatobiliary & Pancreatic Surgery 10.80 £673,749 3,456 1
Infectious Diseases 16.34 £638,346 3,793 1
Spinal Injuries 21.44 £636,492 3,473 1
Spinal Surgery Service 14.22 £620,018 3,289 1
Cardiothoracic Surgery 10.09 £601,005 3,114 1
Interventional Radiology 15.81 £589,496 3,219 1
Thoracic Surgery 10.49 £581,601 3,149 1
Palliative Medicine 16.66 £580,120 3,000 1
Rheumatology 16.81 £515,582 2,663 1
Ophthalmology 14.33 £457,116 1,933 1
Paediatric Medical Oncology 14.05 £448,812 1,664 1
Hepatology 13.24 £445,378 2,301 1
Paediatric Gastroenterology 19.41 £413,690 1,535 1
Paediatric Respiratory Medicine 16.24 £401,452 1,558 1
Obstetrics 14.27 £374,273 1,962 1
Maxillo Facial Surgery 11.62 £347,135 1,551 1
Gynaecological Oncology 10.63 £328,377 1,430 1
Paediatric Trauma and Orthopaedics 12.76 £319,764 1,324 1
Oral Surgery 11.64 £281,383 1,275 1
Paediatric Clinical Haematology 16.78 £278,188 990 1
Paediatric Neurology 19.86 £269,060 1,023 1
Paediatric Intensive Care 17.49 £268,405 1,138 1
Paediatric Cardiac Surgery 12.41 £252,285 1,094 1
Dermatology 17.55 £238,129 1,145 1
Breast Surgery 9.48 £227,876 1,108 1
Paediatric Neurosurgery 13.43 £208,522 943 1
Paediatric Cardiology 17.21 £208,169 910 1
Paediatric Ear Nose and Throat 10.92 £179,304 619 1
Transient Ischaemic Attack 17.74 £159,556 882 1
Transplantation Surgery 14.73 £140,648 681 1
Paediatric Nephrology 16.21 £130,848 475 1
Paediatric Interventional Radiology 19.32 £123,165 492 1
Anaesthetics 16.66 £112,461 728 1
Pain Management 17.30 £92,021 486 1
Burns Care 19.57 £78,443 404 1
Paediatric Plastic Surgery 13.24 £72,242 295 1
Paediatric Urology 10.00 £68,149 233 1
Midwife episode 14.47 £67,454 598 1
Clinical Pharmacology 16.43 £56,955 378 1
Paediatric Metabolic Disease 19.21 £47,012 169 1
Paediatric Rheumatology 19.98 £42,063 146 1
Bone & Marrow Transplantation 16.17 £34,258 191 1
Paediatric Endocrinology 13.98 £33,013 120 1
Respiratory Physiology 4.29 £32,902 176 1
Paediatric Infectious Diseases 17.05 £32,856 113 1
Sport and Exercise Medicine 11.82 £22,204 111 1
Paediatric Clinical Immunology and Allergy 19.25 £20,638 75 1
Paediatric Diabetic Medicine 14.59 £17,062 59 1
Paediatric Dermatology 15.83 £13,198 51 1
Congenital Heart Disease Service 13.25 £13,125 69 1
Paediatric Burns Care 19.85 £12,401 55 1
Chemical Pathology 14.96 £11,177 58 1
Diagnostic Imaging 10.46 £10,186 46 1
Paediatric Ophthalmology 9.46 £9,972 35 1
Haemophilia 18.07 £9,457 41 1
Paediatric Dentistry 14.52 £8,648 30 1
Paediatric Maxillo-facial Surgery 8.50 £6,302 21 1
Tropical Medicine 11.85 £5,832 30 1
Clinical Neurophysiology 7.05 £3,663 17 1
Orthoptics 19.97 £3,652 17 1
Paediatric Epilepsy 8.74 £2,948 12 1
Paediatric Gastrointestinal Surgery 14.34 £2,623 10 1
Clinical Immunology 13.33 £2,526 12 1
Restorative Dentistry 18.16 £2,490 12 1
Allergy 18.09 £1,755 9 1
Genitourinary Medicine 12.92 £1,559 8 1
Clinical Immunology & Allergy 17.50 £1,468 7 1
Paediatric Neuro-disability 13.51 £1,418 5 1
Podiatry 6.82 £946 5 1
Medical Ophthalmology 10.42 £908 4 1
Clinical Microbiology 19.44 £729 4 1
Physiotherapy 8.78 £677 3 1
Dental Medicine Specialties 11.25 £598 2 1
Community Paediatrics 10.00 £526 2 1
Paediatric Thoracic Surgery 6.25 £468 3 1
Nuclear Medicine 1.75 £367 2 1
Orthodontics 14.29 £277 1 1
Cardiothoracic Transplantation 7.35 £250 1 1
Clinical Genetics 5.36 £214 1 1
Audiology 9.09 £190 1 1
Anticoagulant Service 4.41 £140 1 1
Paediatric Pain Management 12.50 £100 1 1
Clinical Physiology 3.13 £51 0 1
Cardiac Rehabilitation - - 0 1
Clinical Psychology - - 0 1
Optometry - - 0 1
Orthotics - - 0 1
Paediatric Audiological Medicine - - 0 1

Length of hospital stay is one of the greatest variables between NHS trusts. By reviewing and improving admission and discharge processes, trusts can improve the patient experience by reducing the number of days spent in hospital, and save bed days thus increasing capacity and saving money.

As a measure of the scope for improving length of stay we have looked at the number of bed days beyond the average length of stay for each of combination of Healthcare Resource Group, age, sex and social deprivation. We have taken a quarter of this figure as being an achievable level of improvement and expressed it as a percentage of all the Payment by Results bed days at the trust.

The figures are intended to give an idea of the potential for improvement. However, some hospitals would expect to have patients stay longer than the average for patients with the same age, sex and other characteristics. For example, within each HRG some hospitals (eg specialist trusts) may have more complex patients. Also trusts which serve large geographical areas, with patients travelling long distances, may need to have patients stay longer.

There is usually more variation between hospitals in the pattern of discharge than in the pattern of admission. For all hospitals, discharge rates generally peak on Fridays and drop steeply during the weekend. While patients are admitted seven days a week as emergency admissions, most are discharged on five. For patients admitted as an emergency, the reduction in discharges over the weekend compared to weekdays varies from over 75% to less than 15%.

The day of admission also affects the length of time patients with similar clinical requirements stay in hospital. A patient who is admitted on a Friday may have a length of stay 25% longer than a patient admitted on a Tuesday.

Reducing length of stay will reduce the cost per patient episode, the risk of patients being exposed to hospital acquired infections, A&E waits, cancelled elective procedures and waiting times for treatment thus improving clinical outcomes.

Key steps :

  • Benchmark length of stay performance in as much detail as possible down to HRG, operation and even consultant or ward level to identify opportunities for improvement
  • Map processes in order to identify potential delays to patients discharge. This analysis should focus on identifying bottlenecks, any disruption to the information flow during the patient journey and on patterns of discharge by day, hour and specialty.
  • Give patients a planned date for discharge on, or prior to, their admission. This date should be based on protocols for common conditions. The patient, their family or carer, and where necessary social services, should then be involved in individual discharge planning.
  • Discharge patients daily. A regular decision-making ward round should take place at least once per day, including weekends. Staff rotas may need to be adjusted to facilitate this.
  • Discharge patients throughout the day. Criteria-led discharge by nurses and other healthcare professionals facilitates discharge at other times of the day, other than the daily ward round.
  • Prevent hospital procedures from holding up discharge. Lead-in times for processes required for discharge, including tests and results availability, medicines, transport and social services, should be determined so that measures can be taken to ensure that they do not hold up patient discharge.
  • Ensure that the admissions and discharge processes work seamlessly together. Patient discharges peak late in the afternoon, while the peak for admissions is usually earlier.

Further Information

NHS Elect –Service Transformation Tools

http://www.nhselect.nhs.uk/Service-Transformation

Information Shown

This indicator shows a percentage bed day saving and associated financial productivity opportunity to be realised by amending processes such that the length of stay of patients over the median value for the casemix group is reduced by 25%. This is expressed as a percentage of all PbR spell bed days in the trust. The data is stratified so that patients of similar age, deprivation, HRG and gender are compared with one another. The bed day saving and productivity opportunity is calculated at the granular level before being aggregated and a provider is likely to show a saving opportunity unless all lengths of stay are below the relevant median value. Organisation Dashboard The following information is displayed for Reducing Length of Stay. Latest value - Percentage bed days in excess Financial Opportunity - This shows the financial value of the number of bed days in excess of the percentile value shown. This is calculated by multiplying the excess bed days by the excess bed day tariff. Volume Opportunity - This shows the number of bed days that have been used to calculate the financial opportunity based on the percentile value shown. Rank - This shows the position of the trust when ranked against all trusts.

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